Yet more medical ramblings

The Midwest is home to some pretty crazy weather. Thirty-five years ago this month a tornado tore apart the new, rapidly-growing Detroit suburb of West Bloomfield. MrsPal was looking through pictures of the aftermath saying, “That was so-and-so’s house. And that one was across from…” etc. Everyone knew someone whose body or property was damaged. I knew a kid who had scars all over his body from a house collapsing around him. He had the same name as another local kid, so we always would say things like, “No, not that Steve, tornado Steve.”

Tonight, it’s not stormy, but something is falling from the sky that isn’t hail, isn’t sleet, isn’t snow, isn’t rain. Whatever it is, it hurts, and I have to chip away at my car door to get in. We just got back from dinner. A local Lebanese place has great fish during Lent (the rest of the year, feh). It’s a whole Great Lakes whitefish, fried, and covered in lemon juice, garlic, and other yummy things. Before that we were at a shiva, the reason for braving the weather in the first place. The decedent had been a patient of mine, but I also knew him socially. I met him many years ago when he and his wife, neither of them terribly young, were sitting in my office holding hands and making eyes at each other like drunken teenagers.

He was concerned about his memory. He was a brilliant medical professional, and he and his wife visited all the local experts and had been unable to avoid the conclusion that he was becoming demented. Oh, but they were so in love, and while they were frightened and sad, they had each other.

That was ten years ago, and his life went on as these things often do, with those around him trying to lead normal lives while a man they deeply loved slowly but surely disappeared. It is one of the privileges and one of the sorrows of medicine to develop uniquely intimate relationships with strangers only to preside over their decline.

I’ve been in practice about ten years now. The recent move to a new practice, which has kept me away from the keyboard, took a bit of work. One of the most unsettling tasks was going through a list of thousands of patients to contact and weeding out the dead—it’s bad form to send letters to dead people. Each time I would come upon a name, I would halt and see an image of them, remembering their voice, the way they lived, the way they died. Sometimes, I wasn’t sure if they were dead—maybe they just hadn’t been by in a while, but they sure were old. I would cross-check various databases and then delete their name from the mailing list, wondering how they had left.

While I may see a lot more of my older, sicker patients, I know that the younger ones will eventually spend more time with me, around the same time I start seeing my own doctor more than once a year. It reminds me that every night that my daughter pesters her mother at bedtime whining for Daddy, I should be there. Every second with my family, even the “bad” seconds, are precious. It seems that it would be easy to accumulate regrets in life, many of which are seen best in retrospect. Perhaps I can learn this sooner rather than later, that despite being carded at a restaurant last week, time isn’t infinite, childhood cannot be taken for granted, and no one has ever said at the end of their life, “I wish I’d spent more time at work and less with my family.”

namnezia

A. Marina Fournier

That you were sitting shiva for an old friend, and then went on to a Lebanese restaurant makes me smile, as it is the sort of thing I might do, were I near a Lebanese restaurant–don’t seem to be any in the Bay Area. Same thing with a good Jewish deli, darn it. I have yet to get to Dearborn, as my sister did, and she exclaimed at the quality and ubiquity of Lebanese food there.

I haven’t had really good Lebanese food since I left San Diego, where I had spent 10 of my 18 years, to go up to college. I have a hard time finding places that make tabbouli correctly, including the lemon juice and mint. Shortly after we moved to San Diego, a Lebanese, not a Syrian, Turkish, Greek, or Persian, restuarant opened up, and our Lebanese mother took us there every few months, when there was enough money to do so (what child support?). My mother having a great way of becoming friends with people she saw often enough, we were welcomed warmly every time we were there.

My in-laws were like that older couple–it was a second marriage for each of them, and this one was so much better and more joyous than their first ones. When Irby died in 2008, there was a series of us taking shifts at his bedside so that Edna could get the sleep she needed. He had finally been declining steadily from CHF in the last 18 mos., and if she could avoid it, Irby was not going to die in a hospital. His mind didn’t go, but as with my grandfather, his body betrayed him. The plan had always been that she’d move in with her son when Irby died, and once we married, having met her, I had absolutely no problems with that. They moved in with us earlier than planned. Edna worries about her mind going (which I don’t think it is), being a burden (she’s not), and wondering whether she’ll need to go to a care home in years to come (we’ll see)–but meanwhile, I for one am really happy to have another adult in the house to be with.

After my mother’s stroke in 1994, a stranger I didn’t care for took over my mom’s body. It was a relief when she died ten years later. I have a friend about 90 min. away, whose husband is in the early stages of dementia, cause and exact diagnosis undetermined, and she has no idea how long it will be that she has him at home. As with my sister, who cared for our mom at her home for six years before she couldn’t do it anymore, I will support *her* needs, since I can’t do anything about his.

When I was in college, and I’d be downtown in the village, I’d see older couples from one of the three retirement communities in the town, walking together, hand in hand. I wish I could say my marriage was that warm, but I can’t right now.

On on email list I’m on, we were just now talking about continuity of care with one physician, and how it’s hard to do anymore with employer insurance changing often, even if you haven’t changed employers, and never knowing if the physicians you see this year will be the ones who’ve had a chance to get to know you, or whether the doctors you CAN see will be right for you. I have had to fire a few PCPs, a couple of OB/GYNs and dentists, and one psychiatrist for me and one of my son’s (we’re bipolar) over the years, for varying reasons. I am certainly happy with the care I have now, and appreciate being able to email my pdoc, dentist, and PCP (an endocrinologist, as I also have Metabolic Syndrome (sigh)) to keep them up with my information between visits, as well as to send them interesting articles in their field they might not have seen yet.

It is sad enough for me to take people out of my contacts list when they die: I do not envy you your task with yours.

As to being home with family, I try to make sure that my projects & plans don’t leave my teen son at home with no one to hang with. He’s a good kid, and our bond had a better chance to deepen once my meds were stabilizing me enough so that I could be a parent instead of an adult with problems. He still wants to be around us, and get hugs, and I know how lucky I am for this.

Melissa (aka DrSnit)

This is the most beautiful post. It is true – none of us gets out of here alive. We are on a terminal track. And YES- looking back – NONE OF US looks back and says, “Those days at work were more important than the relationships I made.”

Thank you for sharing this and writing this. It is truly beautiful. A good reminder for all of us.
x
Melissa

Dr. Dredd

“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming “Wow! What a Ride!”
— Hunter S. Thompson

Add to Thompson’s advice: Spend more time with your family.

Dianne

no one has ever said at the end of their life, “I wish I’d spent more time at work and less with my family.”

I don’t know…my mother arrived at middle age with regret that she’d done what was expected of her, aka have 2 kids and spend all her time with her family, rather than spending time developing her own abilities. Spending time with your family when you feel you have no choice can feel pretty empty too.